Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
GDC Electrical Services Solicitation State and local contract opportunity
Solicitation number
SRC0000029429
Issued by
Gallia County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form, seemingly for a state government (likely Ohio) procurement process. The form is designed to collect comprehensive details about a potential contractor for a Request for Proposal (RFP), with a revision date of May 2024. The form requires contractors to provide basic company information, contact details, employee demographics, DODD certification status, and OAKS Supplier ID or Tax Identification Number. It also requests nationwide and Ohio-specific employee information, including total employee count and percentages of women and minorities.

The form is critical for RFP eligibility, as noted in the footer stating that it must be completed, signed, and submitted with the proposal to be considered for review and scoring. Contractors must affirm they meet minimum qualifications specified in the RFP's Part Two: Section IV and provide contact information for the person authorized to execute a contract. Additionally, if applicable, contractors must indicate a separate remittance address different from their primary mailing address. The form appears to be part of a structured procurement process that emphasizes transparency, diversity, and detailed contractor disclosure.

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File Type Posted
GDC Electric RFQ Document (open).docx DOCX document
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf PDF

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CONTRACTOR INFORMATION FORM

STATE: ZIP CODE:

CONTRACTOR NAME:

STREET ADDRESS:

CITY:

OFFEROR CONTACT NAME:

PHONE NUMBER: EMAIL:

Current number of employees:

Percent of Women:

Percent of Minorities:

Authorized Signature Date

Contractor affirms that they meet the minimum qualifications identified in Part Two: Section IV of the RFP title:

This form must be completed, signed, and submitted with RFP Proposal for it to be considered eligible for review and scoring. Rev. 5/2024

1. DODD certified provider? NO YES, DODD Provider Certification #

2. Provide OAKS Supplier ID or Tax Identification Number:

3. Current employee information on both a nationwide basis (including Ohio), and for Ohio operations.

(enter RFP Title and RFP Number beginning with SRC)

Nationwide Ohio

4. If your remit to address is different than the mailing address above, pleas provide below:

Street Address:

City: State: Zip Code:

5. Provide contact information for person with authority to execute a contract on behalf of the contractor.

Name: Title:

Email:

Krista Shaw Line

Krista Shaw Line

Krista Shaw Line

STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
PHONE NUMBER:
EMAIL:
NATIONWIDE 1:
NATIONWIDE 2:
NATIONWIDE 3:
OHIO 1:
Provide OAKS Supplier ID or Tax Identification Number:
Street Address:
Zip Code:
Date:
Check Box1: Off
CONTRACTOR NAME:
RFP Name & SRC #:
OHIO 2:
OHIO 3:
City:
State:
AUTHORIZED CONTACT NAME:
Signatory Name:
Signatory Title:
Signatory Email:
Check Box2: Off
Check Box3: Off
Certification #:

File details come from the government source that posted it. Updated .